Morbidity in Testicular Cancer Survivors Treated With Standard Cisplatin-Based Chemotherapy
In a study reported in the Journal of Clinical Oncology, Kerns et al found that approximately 20% of testicular cancer survivors treated with cisplatin-based regimens had high cumulative burden of morbidity (CBM) scores and identified factors associated with risk for increased morbidity.
Study Details
The study population consisted of 1,214 patients from the testicular cancer cohort of the international multicenter Platinum Study. Participants were aged ≤ 55 years at diagnosis and had completed first-line cisplatin-based chemotherapy ≥ 1 year prior to enrolment. CBM scores were generated that reflected number and severity of adverse health outcomes. Patients had a median age of 37 years at evaluation, and median time since chemotherapy was 4.2 years.
CBM Scores and Risk Factors
Among all patients, CBM scores were very high/severe in 4%, high in 15%, medium in 30%, and low/very low in 47%. Risk factors for higher scores included treatment with 4 cycles of either ifosfamide, etoposide, and cisplatin (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.04–3.71) or bleomycin, etoposide, and cisplatin (OR = 1.44, 95% CI = 1.04–1.98); older attained age (OR = 1.18, 95% CI = 1.10–1.26); current disability leave (OR = 3.53, 95% CI = 1.57–7.95); less than college education (OR = 1.44, 95% CI = 1.11–1.87); and current or former smoking status (OR = 1.28, 95% CI = 1.02–1.63); CBM scores did not differ between the 2 chemotherapy regimens (P = .36). Lower scores were associated with Asian race (OR = 0.41, 95% CI = 0.23–0.72) and vigorous exercise (OR = 0.68, 95% CI = 0.52–0.89).
Variable clustering analyses identified 6 significant adverse health outcome clusters (χ2 P < .001): hearing loss/damage, tinnitus (OR = 16.3); hyperlipidemia, hypertension, diabetes (OR = 9.8); neuropathy, pain, Raynaud phenomenon (OR = 5.5); cardiovascular and related conditions (OR = 5.0); thyroid disease, erectile dysfunction (OR = 4.2); and depression/anxiety, hypogonadism (OR = 2.8).
The investigators concluded, “Factors associated with higher CBM may identify testicular cancer survivors in need of closer monitoring. If confirmed, identified [adverse health outcome] clusters could guide the development of survivorship care strategies.”
The study was supported by grants from the National Cancer Institute.
Lawrence H. Einhorn, MD, of the Indiana University Melvin and Bren Simon Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.
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